If posting frequency is any indication, regular readers might be able to tell that the last two or three weeks have not been the highlight of my life. And, thankfully for you, I’ve kept much of it off-blog because of the unique personal identifying characteristics than prevent me from being too honest here. But, let it suffice to say that several friends of mine and old lab colleagues have had deaths of family members due to cancer, two of which were at painfully young ages…not that there’s any ‘good’ time to die of cancer.

Is this odd? Do my recent experiences represent a statistical anomaly?

Well without dragging MarkCC, Tara, or Revere into the discussion, let’s just figure this: the US is about to hit 300 million in national population and the last NCI SEER documents about 550,000 cancer deaths in the US annually. That means to me that the average American has a 1 in 550 chance of having someone close to them die of cancer this year. Let’s say most of us have about 110 friends and extended associates – to me that means that you have a reasonable chance of one closely related friend dying of cancer every 550/110 or 5 years. Even if you say that the 110 people I know each have five immediate family members, that’s really only one death from cancer per year.

Now, I’m not an idiot. I recognize that as one gets older, the chances of having a close friend die of cancer increases. So, maybe I’m feeling badly for no statistically significant reason, whatever that means emotionally. And, frankly, I’ve had a lovely week, visiting with collaborators and meeting some of my SiBlings and Seed Media Group caretakers/editors (hey Katherine, what do you prefer to be called – I used to use “den mother” but that somehow doesn’t seem professional enough given that you are a published author and editor.). Really lovely stuff: even having beers with PharmSis near Grand Central Station and, be-still-your-heart, a special session of beer-drinking and experimental planning the next day at McSorley’s Old Ale House with my blogging mentor, Orac. I should be bristling with happiness and excitement, right?
Well, death seems to be following me around – I now realize why the folks at Seed Media Group were all fighting over who wouldn’t have to stand next to me for the pictures we took during the tour. Even checking my e-mail, (the blog one, not my professional one), I got a notice for a professional meeting: the 16th International Congress on Care of the Terminally Ill, to be held September 26-29, 2006 at the Palais des Congres in Montreal, Canada.

Then, onto the next e-mail: So, I had this girlfriend…she and I loved this certain local band and the trademark on their swag was a very cleverly-taken and emotive picture of a dog in a unique setting that, coincidentally, was adapted for the band’s use by Terra Sig masthead/banner artist and illustrator, Brien O’Reilly. In fact, correct me if I am wrong, but Brien won a Connecticut Art Directors’ Guild award (a gold medal, I think) for his work with this band. Well, unbeknownst to me at the time, Former Girlfriend was friendly with the owner of this dog and several other dogs of importance to the graphic, commercial representations of this local band. A small world, indeed, even for her.

Well, I learned that this locally-famous dog is no more.

She wrote me this week to inform me that she participated in the humane euthanasia of the most publicly visible of these celebrity dogs whose owner turned out to be a very close friend. (For context, Former Girlfriend was a US Air Force brat who knew so many people that you could be walking with her in Manhattan, Chicago, DC, or the backwoods of North Florida, and she’d run into someone she knew.). The loss of this icon is, of course, not surprising since the musical group in question has been in operation for 16 years, slightly outside the normal lifespan of the majority of domestic canines. (Love and condolences to Nancy…Thanks for the picture, Scott…To Mocha: Good dog…always.)

So, I’ve seen or heard of a number of very young people, within one degree of separation from me, die of some malignant neoplasm or liquid cancer. Now, a very close dog friend. But, Reaper, dude, do you have to be so cruel to get my attention?

NYC Epilogue
While in NYC the other night, unable to sleep after PharmSis took the train home, I thought that I might travel downtown to a place where I might have a face-to-face with the Reaper or one of his designees – the Ground Zero crater of the World Trade Center towers. The Pharmboy lost someone there five years ago who was very key in his childhood and a source of encouragement in pursuing a scientific career, or at least protecting him from getting the crap beaten out of him in Catholic school because of his adolescent geekdom.

The cab left me at St. Paul’s Chapel and Cemetery, Manhattan’s oldest continuously-used building where George Washington worshipped on the morning of his inauguration (NYC was the US capital for two or three years then before DC) which is recreated every 30th of April at 11:45 am. St. Paul’s also served as a place of rest and refuge for WTC recovery workers for at least a year following the terrorist attacks. In the cemetery surrounding St. Paul’s, just across from the WTC, are gravestones dating from the late 1700s and early 1800s, testament to a life of suffering and struggle for survival that long preceded the 2001 terrorist attacks. In those days, a large percentage of people never even made it to 38, the median age of those killed in the WTC.

There was something terribly painful but remarkably sterile about being down to the WTC five years later. Painful to see the name of a friend on a makeshift memorial to over 2900 others, knowing that his family’s suffering has been amplified thousands of times in the US and overseas, not to mention those families newly suffering the consequences of an incorrectly-targeted, misguided, and poorly-executed military campaign, whether they be families of innocent Iraqis or coalition forces. The fact that a real, thoughtful and permanent memorial will not be completed in time for 11 Sept 2006 is an equally poignant metaphor for the mismanagement, clash of ideologies, and inability to come to consensus common to both the Bush administration and WTC memorial leadership, the latter of which is finallymaking some progress thanks to many of the families.

The hole in the sky has to be seen to appreciated in its immensity, even at 2 am it was gut-wrenching. The Bruce Springsteen song, “Empty Sky,” from The Rising is not melodrama for those of us who grew up in sight of the NYC skyline. When taking the PATH train from Hoboken 25 years ago for a Spanish National Honor Society dinner in preparation for my high school trip to Spain, I remember us getting right up close to one of the towers and looking up, feeling a sense of indescribable unease being at the base of something so amazingly huge, yet man-made.

I’ll have more to say about this in about a month or so…

I grabbed a cab back to my hotel around 2:40 am, with the cabbie looking at me in disgust and shaking his head. “A guy looking like you, carrying a camera here in the middle of the night? I’m surprised the cops didn’t beat the crap out of you,” he said, reminding me of how my departed friend in the WTC had protected me in high school from similar threats. His implication was that my goatee, darker olive skin of summer, and choice of timing while carrying a high-res digital camera might have targeted me as a person of suspicion…for what, I don’t know. It seems that there are very strict rules about where and when one can take photographs down there but, to be honest, I only got off two or three pictures before sobbing made it impossible to focus even a digital camera.

What message is there in these deaths that have come across my plate lately?…close enough to stun but not so close enough as to debilitate. I was reminded of my sister’s gift of one of Dr Bernie Siegel’s many books, a retired oncologist who observed that facing death finally gave people permission to fully live their lives. A very dear Colorado friend had also sent us home with some books, including “Buddhism Without Beliefs” by former monk, Stephen Batchelor, that includes the following meditation on death:

Since death alone is certain and the time of death uncertain, what should I do?

It’s really a lovely idea that at first may seem somewhat morbid in that a death meditation paradoxically makes one more conscious of life. Batchelor notes that only when we lose something do we recognize its true value – like when one forgets to pay the water bill and returns home from vacation on a Saturday night to the realization that one’s home has no running water and nothing can be done about it until Monday.

As Batchelor says, “How extraordinary it is to be here at all.” I think this very thought whenever I do/did experiments on gene mutagenesis, thinking just how common it is for us to incur cancer-causing mutations from just sunlight and the use of oxygen to create ATP. How we even make it to biologically reproductive age is simply amazing if not a miracle of multicellular evolution.

Again, Batchelor:

“Awareness of death can jolt us awake to the sensuality of existence. Breath is no longer a routine inhalation of air but a quivering intake of life. The eye is quickened to the play of light and shade and color, the ear to the intricate medly of sound. This is where the meditation leads. Stay with it; rest with it. Notice how distraction is a flight from this, an escape from awe to worry and plans.”

But, yes, this is ScienceBlogs, and I spend most of my time here and in the reality-based community fighting alternative medicine misinformation and false hope. But, equally, we, our blog-leagues, and other loved ones are all equally prone to this sexually-transmitted, terminal disease called life. Certainly, none of us are immune to the emotional pain and wonder of life and death. I may not be as eloquent as Dr Aidan Charles or Dr Craig Hildreth, perhaps in part, because I don’t face the Reaper every day, holding the hands of my patients.

But, clearly, someone is trying to teach me to learn from death how to live life…before it gets too close.

Ahh, yes. Those of us who deal with death on a daily basis must remind ourselves frequently that it has many dimensions not revealed by our numbers. One of the great epidemiologists once said that statistics are real people with the tears wiped away. Those of us who make a living counting up dead bodies have to keep it in mind. One of the more poignant thoughts I remember is that of Sartre: Death only happens to other people. I too am living through the sudden death of a contemporary (and father of my last graduate student) so it is much on my mind. I know too many people my own age who leave the house in the morning and don’t come back at night.

As for the actual numbers,500,000 to 600,000 people die each year from cancer. That means that on a daily basis about 1500 people will die of cancer. That’s also roughly ten to fifteen times the number that die in this country from auto accidents. This gives some benchmark on a person’s daily experience of other causes of death, imperfect as it is. As you note, our own experience is heavily colored by the mortality of contemporaries and as we age, that experience includes more and more cancer along with heart disease. Data show that cancer incidence (the actual risk of being diagnosed with cancer) is mainly steady, but decreasing in some and increasing in other sites. So it is a complex picture. The more important question, from the public health point of view, is how many of the current cases were preventable and how many more in the future could be prevented if we acted now.